Medicare 2026

Before You Pick a Medicare Path, Know How These Two Work

CLARKSBURG, W.Va. — If you're turning 65 in Clarksburg, or helping a parent sort through the mail piling up on the kitchen table, you've probably run into the same fork in the road every new Medicare beneficiary faces. On one side sits Original Medicare, often paired with a Medigap policy and a standalone Part D drug plan. On the other sits Medicare Advantage, which bundles everything into a single plan run by a private insurer.

They can look similar in a brochure. Structurally, they work very differently — and understanding that difference before you enroll is the single biggest way to avoid a costly mistake later.

Two different systems, not two flavors of one

Original Medicare is the federal program itself — Part A (hospital) and Part B (doctor and outpatient). You can go to almost any provider in the country that accepts Medicare. There's no network, and no referrals.

Medicare Advantage (Part C) is different. When you enroll in an Advantage plan, a private insurer takes over administering your Part A and Part B benefits. You still have Medicare, but the plan sets the rules — the network of doctors, the prior authorization requirements, and the copays.

That's the core structural split. One is a government program you use directly. The other is a private plan that stands in for it.

Where Medigap fits in

Original Medicare pays most, but not all, of your covered costs. There are deductibles and coinsurance, and there is no yearly cap on what you could owe out of pocket. That's the gap Medigap (also called Medicare Supplement Insurance) is designed to fill.

A Medigap policy only works with Original Medicare. You cannot use Medigap with a Medicare Advantage plan — the two aren't designed to combine. Medigap plans are standardized by letter (Plan G, Plan N, and so on), so the same lettered plan offers the same benefits from any carrier, though premiums vary.

One important timing rule: you get a one-time, six-month Medigap Open Enrollment Period that starts when you're 65 and enrolled in Part B. During that window, insurers can't turn you down or charge more because of your health. Outside that window, in most states including West Virginia, they can.

How drug coverage works in each path

If you choose Original Medicare, you'll typically add a standalone Part D prescription drug plan. If you choose Medicare Advantage, drug coverage is usually built into the plan.

Either way, the same Part D rules apply in 2027:

• The annual out-of-pocket cap for covered drugs is $2,400.
• The maximum Part D deductible is $700.
• The old "donut hole" coverage gap was eliminated in 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments instead of paying large amounts at the pharmacy counter.

Also worth knowing: if your income is above $109,000 as a single filer in 2026, an IRMAA surcharge is added to your Part B and Part D premiums.

What Clarksburg residents should know locally

Clarksburg is in Harrison County, where Medicare Advantage plan availability is set at the county level by CMS. That means the number of Advantage plans and standalone Part D plans offered here may differ from what's available in neighboring counties, even a short drive away. When you compare, use your ZIP code on medicare.gov's Plan Finder so you're only looking at what's actually offered where you live.

Medigap availability is different — plans are sold statewide in West Virginia, and the standardized letters let you compare apples to apples.

The trade-offs to think through

There's no universally "right" answer. The honest way to think about it:

• Original Medicare + Medigap + Part D: broader provider choice, more predictable out-of-pocket costs once you factor in the Medigap premium, and no network restrictions. Higher monthly premiums are the trade-off.
• Medicare Advantage: often lower monthly premiums, extra benefits some plans include, but you'll use the plan's network, may need referrals or prior authorization, and your costs can vary based on the services you use.

Your health, your doctors, your travel habits, and your budget all matter here. So does whether you might want to switch later — moving from Medicare Advantage back to Original Medicare with a Medigap plan is allowed, but medical underwriting may apply outside protected enrollment windows.

Key dates to remember

• Annual Enrollment Period (AEP): October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare.